Provider Demographics
NPI:1629192752
Name:POLLEY-BASS, JANE (LMFT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:POLLEY-BASS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10206 SPRINGHURST GARDENS CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-5195
Mailing Address - Country:US
Mailing Address - Phone:502-409-3801
Mailing Address - Fax:
Practice Address - Street 1:10206 SPRINGHURST GARDENS CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-5195
Practice Address - Country:US
Practice Address - Phone:502-409-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist